title: Dysfunctional family environment in affected versus unaffected offspring of parents with bipolar disorder.
abstract: OBJECTIVE
  Children of parents with bipolar disorder (BD) are at heightened risk for developing mood and other psychiatric disorders. We proposed to evaluate the environment of families with at least one parent with BD type I (BDF) with affected offspring (aBDF) and unaffected offspring (uBDF) compared with control families without a history of DSM-IV Axis I disorder (CF).
  
  
  METHODS
  We used the Family Environment Scale (FES) to evaluate 47 BDF (aBDF + uBDF) and 30 CF. Parents were assessed through the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Diagnosis of the offspring was determined through the Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) interview.
  
  
  RESULTS
  There were statistically significant differences between aBDF, uBDF and CF in cohesion (p = 0.003), intellectual-cultural orientation (p = 0.01), active-recreational orientation (p = 0.007), conflict (p = 0.001), control (p = 0.01), moral-religious emphasis (p = 0.01) and organization (p = 0.001). The aBDF showed higher levels of control (p = 0.02) when compared to the uBDF.
  
  
  CONCLUSIONS
  Families with a BD parent presented more dysfunctional interactions among members. Moreover, the presence of BD or other psychiatric disorders in the offspring of parents with BD is associated with higher levels of control. These results highlight the relevance of psychosocial interventions to improve resilience and family interactions.
authors.affiliation: 1Bipolar Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Guilherme S
authors.initials: GS
authors.lastname: Ferreira
authors.forename: Carolina R L
authors.initials: CR
authors.lastname: Moreira
authors.forename: Ana
authors.initials: A
authors.lastname: Kleinman
authors.forename: Edmir C G P
authors.initials: EC
authors.lastname: Nader
authors.forename: Bernardo Carramão
authors.initials: BC
authors.lastname: Gomes
authors.forename: Ana Maria A
authors.initials: AM
authors.lastname: Teixeira
authors.forename: Cristiana C Almeida
authors.initials: CC
authors.lastname: Rocca
authors.forename: Mark
authors.initials: M
authors.lastname: Nicoletti
authors.forename: Jair C
authors.initials: JC
authors.lastname: Soares
authors.forename: Geraldo F
authors.initials: GF
authors.lastname: Busatto
authors.forename: Beny
authors.initials: B
authors.lastname: Lafer
authors.forename: Sheila C
authors.initials: SC
authors.lastname: Caetano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000523:psychology*; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology*; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D035781:Siblings / Q000523:psychology*
keywords: Adolescents; bipolar disorder; children; family environment; offspring